Redefining Cultural Competence for MSM of Color Through System Transformation

Transcription

1 Redefining Cultural Competence for MSM of Color Through System Transformation Michael Shankle; Dawn Maker; Dana Cropper-Williams; Darwin Thompson Director of Capacity Building, HealthHIV; Education Manager, HealthHIV; Director of Education, HealthHIV; Executive Director, NAESM 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

2 Disclosures Presenter(s) has no financial interest to disclose. This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with HSRA and LRG. PESG, HSRA, LRG and all accrediting organization do not support or endorse any product or service mentioned in this activity. PESG, HRSA, and LRG staff has no financial interest to disclose NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

3 Learning Objectives 1. Describe how cultural competence within healthcare organizations impacts the health of MSM of Color. 2. Identify barriers exacerbated by an organization s lack of cultural competence. 3. Recite culturally appropriate mechanisms and procedures that are responsive and accepting of MSM of Color. 4. Identify strategies that address system transformation within health departments, ASOs and CBOs by redefining cultural competence. 5. Recognize the importance of ongoing professional development to enhance cultural competence within healthcare organizations NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

4 Defining Cultural Competence 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

5 Cultural Competence Cultural competence is not an end goal, but a commitment to an ongoing engagement with welcoming and affirming behaviors, knowledge, attitudes and policies. Cultural competence presentations and trainings are understood to be a beginning and an important step in learning to work more effectively with clients/patients, but they are not the only required step. Profound change also requires time, practice and self-reflection NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

6 Cultural Competence Cultural competence is a set of behaviors, attitudes, and policies that creates effective work in crosscultural situations. Implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by patients/consumers and their communities. In summary, cultural and linguistic competence IS A SKILL!!

7 Group Brainstorm What are the benefits of becoming a culturally competent health care organization? How can cultural competence impact health outcomes?

8 Benefits of Becoming a Culturally Competent Health Care Organization Health Research & Educational Trust. (2013, June). Becoming a culturally competent health care organization. Chicago, IL: Illinois. Health Research & Educational Trust Accessed at

9 MSM of Color and Negative Experiences with Health Care System 24% of Black MSM report they have been mistreated by health care provider because of race 29% of Black MSM report they have been mistreated by health care provider because of sexual orientation 78% of Black MSM report they have felt deceived or misled by health care provider 34% of Black MSM indicate that people of their race don t receive the same level of quality care as people of other races Less than half of Hispanics/Latinos with HIV are receiving medicines to treat their infection Eaton, L. A., Driffin, D. D., Kegler, C., Smith, H., Conway-Washington, C., White, D., & Cherry, C. (2015). Acknowledging the role of stigma and medical mistrust in engagement in routine health care among Black men who have sex with men. American Journal of Public Health, 105(2), e75 e82. Centers for Disease Control and Prevention; (2016); HIV and AIDS Among Latino NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

10 The HIV Epidemic in the US 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

11 The HIV Epidemic Today Approximately 1.2 million people in U.S. living with HIV 1 50,000 new HIV infections annually, two decades 1 14% of those infected with HIV do not know their status % of new infections attributed to 14% with unknown HIV status 3 32% of people with HIV are diagnosed late into their illness 2, with 24% of those people being diagnosed with AIDS 1 50% of individuals who are aware of their HIV status are not adequately engaged in care, account for 61.5% of new infections 3 1 CDC. (2016). Today s HIV/AIDS Epidemic. February, Kaiser Family Foundation. (2014). The HIV/AIDS Epidemic in the United States. 7 April Skarbinski, J.; Rosenberg, E.; Paz-Bailey, G; Hall, HI; Rose, D; Viall, A; Fagan, JL; Lansky, A; Mermin, J. (2015). Human Immunodeficiency Virus Transmission at Each Step of the Care Continuum in the United States. JAMA Intern Med,175(4), doi: /jamainternmed

12 HIV Care Continuum HIV Care Continuum 100% 90% Percent of all People Living with HIV 80% 70% 60% 50% 40% 30% 20% 86% 80% 40% 37% 30% 10% 0% Diagnosed Linked to Care Engaged in Care Prescribed ART Viral Suppression CDC. (2014). Vital Signs: HIV Diagnosis, Care, and Treatment Among Persons Living with HIV United States, MMWR, 63(47), CDC. (2016). Care and Prevention for People Living with HIV, in Today s HIV/AIDS Epidemic.

13 Selected National HIV Prevention and Care Outcomes in the United States, % 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Percentage of People Diagnosed with HIV in USA 87.0% 65% 74.5% 96% 56.5% 54.7% Diagnosed with HIV Linked to Care Retained in Care Suppressed Viral Load Percentage of People Disgnosed with HIV in USA Centers for Disease Control and Prevention. (2016). Selected National HIV Prevention and Care Outcomes in the United States. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention. July

14 HIV Prevalence and Incidence HIV Prevalence & Incidence, U.S Today s HIV/AIDS Epidemic. February Centers for Disease Control and Prevention. Accessed online at

15 HIV Prevalence Among Black/African Americans

16 HIV Prevalence among Hispanics/Latinos

17 MSM of Color and HIV 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

18 Estimated New HIV Diagnoses Among Men Who Have Sex With Men, by Race/Ethnicity and Age at Diagnosis, 2014 United States Centers for Disease Control and Prevention. (2015). HIV Surveillance Report, 2014; vol Published November pp Graph: Centers for Disease Control and Prevention. (2016). HIV Among African American Gay and Bisexual Men. Page last updated: February 4,

19 Diagnoses of HIV Infection among Men Who Have Sex with Men, by Age Group, United States and 6 Dependent Areas Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting. Data on men who have sex with men do not include men with HIV infection attributed to male-to-male sexual contact and injection drug use.

20 Black MSM Cascade Rosenberg, E. S., Millett, G. A., Sullivan, P. S., del Rio, C., & Curran, J. W. (2014). Understanding the HIV disparities between black and white men who have sex with men in the USA using the HIV care continuum: a modelling study. The Lancet HIV, 1(3), e112-e NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

21 Hispanic/Latino MSM Cascade 100% 40% 23% Graph created from: Bonacci, R. A., & Holtgrave, D. R. (2016). Unmet HIV service needs among hispanic men who have sex with men in the United States. AIDS and Behavior, NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

22 Race/Ethnicity Chart: Source CDC, 2014

23 CROI 2016 Estimated lifetime risk of HIV infection: 1 in 2 Black MSM 1 in 4 Latino MSM 1 in 11 White MSM Highest risks for HIV infection in the South Scaling up current efforts to reach national goals for HIV testing and treatment can prevent 185,000 infections Millions of individuals are not being tested for HIV at routine doctor visits; at current testing rates, less than half of all black men and less than a third of Hispanic and white men will be tested for HIV before the age of 39

24 Group Discussion What are some of the drivers of HIV in the MSM Of Color (Black and Latino) Community?

25 Contributing Factors for Increased HIV Infection and MSM Of Color Increased chance of being exposed MSM of Color do not show greater frequency of HIV risk behaviors compared to white MSM More likely to have sex with partners of the same race/ethnicity High prevalence of HIV infection among MSM of Color Less likely to be engaged in care; thus virally suppressed Lack of awareness of HIV status can affect HIV rates in communities Disproportionately impacted by sexually transmitted infections Higher rates of morbidity and mortality Source CDC, Feb 2014

26 Contributing Factors for Increased HIV Infection and MSM Of Color The poverty rate is higher among African American and Latino communities Stigma, fear, discrimination, homophobia, transphobia and negative perceptions about HIV testing Source CDC, Feb 2014

27 Social Determinants of Health The social determinants of health (SDH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. Circumstances are shaped by Economics Social policies Politics ncepts/en/

28

29 Prominent Social and Cultural Drivers of Health Disparities for Black and Latino MSM Socio- Racism Sexism Heterosexism Cultural Homophobia Implicit Bias Institutional & Structural Racism Inequity Produces Health Disparities for Black and Latino MSM 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

30 Barriers to Culturally Competent Care Lack of diversity in health care leadership and workforce Systems of care poorly designed for diverse patient populations Poor cross-cultural communication between providers and patients, lack of training Patient fears and distrust Cultural and individual stigma Lack of awareness

31 Framework for Culturally Competence Care Organizational Cultural Competence Leadership Governance Policies Systemic Cultural Competence Patients/Clients Family/Caregivers Enhanced services Clinical/Provider Cultural Competence Senior management Clinical Providers Staff (All levels) Education and Training

32 Cultural Competence Road to Success 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

33 Cultural Destructiveness Cultural Destruction Individuals view cultural differences as a problem Individuals purposely attempt to destroy a culture Example: Treatment of Native Americans by immigrants from Europe since 1500 Assumption that one race is superior and should eradicate lesser cultures 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

34 Cultural Incapacity Cultural Incapacity Organizations lack capacity to help individuals from diverse cultures Do not intentionally seek to cause harm Believe in superiority of their own racial/ethnic group Paternalistic Posture Oppress by enforcing racist policies and stereotypes Employment practices are discriminatory 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

35 Cultural Blindness Cultural Blindness Belief that race makes no difference and that all people are the same People view themselves as unbiased Individuals cannot see, and cannot benefit from, the valuable differences among cultural groups Unable or slow to accept that there are important differences between cultural groups Services and programs created by these organizations only meet the needs of dominant groups Lack of capacity to work with different levels or types of risk, need, services, etc NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

36 Cultural Pre-Competence Cultural Pre-Competence Recognition of weaknesses in their attempt to serve various cultures, lack of training and understanding Efforts to improve services to diverse populations, conduct resource and needs assessments Hire one staff member from different cultural/racial background to provide all services needed Belief that they have accomplished their goals and this fulfills their obligation to the diverse community Organization uses the check the box method of achieving cultural competence i.e. hosting one listening session, one forum, or hiring one employee with culturally diverse background 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

37 Cultural Competence Accept and respect differences Cultural Competence Participate in self-assessment process regarding culture & community Conduct constant Resource and Needs Assessments Continuous expansion of cultural knowledge, training, and education for staff and community Adapt service models to better serve the needs of the community Strive to hire unbiased employees and support staff Still occasionally check the box on cultural competence 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

38 Cultural Proficiency Hold diversity of ALL cultures in high esteem Cultural Proficiency Conduct research to increase knowledge of culturally competent practices Develop new educational and therapeutic approaches based on culture Policies, procedures, hiring practices, service delivery, awareness, and education campaigns include principles of cultural competency Note: No one can learn all there is to know about a cultural group in which they are not a member. Therefore, all volunteers and staff members should adopt an attitude of cultural humility NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

39 Small Group Activity 1. Examine the first five steps of the Continuum of Cultural Competency. 2. As a group, identify at least one real world example of how the steps of the continuum are demonstrated in an organizational setting. 3. Propose solutions to improve the cultural competence in the health care setting related to the example identified and using the Framework for Cultural Competent in Health Care (organization, systemic, clinical) NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

40 Model for Cultural Awareness The Heart Health Initiative and Research. (n.d.). Retrieved May 11, 2016, from NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

41 Understand the Local Community Health Research & Educational Trust. (2013, June). Becoming a culturally competent health care organization. Chicago, IL: Illinois. Health Research & Educational Trust Accessed at NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

42 Strategies to Become Culturally Competent Cultural Knowledge Obtain a sound educational base about culturally diverse groups Integrate health-related beliefs and cultural values, disease incidence and prevalence, and treatment efficacy Begin sharing National CLAS Standards with your team 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

43 What are the National Culturally and Linguistically Appropriate Services (CLAS) Standards?

44 National CLAS Standards List

45 Cultural Sensitivity Strategies to Become Culturally Competent Directly engage in face-to-face cultural interactions and other types of encounters Become proactive in addressing cultural competence in your department Continue Self Assessment to keep consistent in your behaviors, communication styles, and interactions with clients 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

46 Difference Between Cultural Competence, Awareness, Sensitivity Cultural competence emphasizes the idea of effectively operating in different cultural contexts, and altering practices to reach different cultural groups Cultural sensitivity and awareness do not include this concept Although they imply understanding of cultural similarities and differences, they do not include action or structural change

47 Cultural Competence Requires Organizations Have a defined set of values, principles, demonstrate behaviors, attitudes, policies, and structures that enable them to work effectively cross-culturally Value diversity Conduct self-assessments Manage the dynamics of difference Acquire and operationalize cultural knowledge Adapt to diversity and the cultural contexts of the communities they serve

48 Cultural Competence Requires Organizations Incorporate in all aspects of policy making, administration, practice, service delivery Involve systematically consumers, key stakeholders, and communities Conduct a developmental process that evolves over an extended period Recognize that individuals and organizations are at various levels of awareness, knowledge, and skills along the cultural competence continuum

49 A Culturally Competent Health Care System Responds to current and projected demographic changes Helps eliminate long standing health disparities Provides culturally competent patient health related information/education Expands choices and access to high-quality clinicians by the public in general Achieves greater patient adherence to medical advice, thereby increasing patient compliance

50 Why is Cultural Competency Important to You? Failing MSM of Color who are contracting HIV at alarming rates Individuals most in need are not being effectively engaged in care or lost to care altogether Communications matters to build provider/client relationships and increase trust Health care system moving to rewarding quality over quantity Avoid being sued for civil rights violations

51 NAESM, Inc. Wellness Care Continuum Department of Prevention & Support Services 2140 Martin Luther King Jr. Drive SW, Atlanta, GA Office:

52 Goal The Goal of NAESM s Department of Prevention & Support Services is to provide a myriad of health and wellness services aimed to enhance access to medical care for eligible people living with HIV/AIDS. Our Client-centered approach supports medical care retention and community linkages.

53 Objectives & Purpose The Objectives are to: Decrease barriers to medical & support services Increase client awareness of treatment options Foster client self-sufficiency through targeted advocacy and support services The Purpose is to support engagement and retention into medical care. This approach emphasizes community linkages to biopsychosocial supports for reducing real or perceived barriers to care.

54 Client Intake Process

55 Abbreviated List of Services Mental & Substance Abuse Counseling Case Management (Non-Medical) Housing Resources Education & Risk Reduction Counseling Food /Essentials Vouchers Transportation Assistance (For Medical Visits) Low-Cost STI Testing & Treatment Support Groups Antiretroviral Linkage

56 Resources NAESM s continuum of care guides clients through a comprehensive array of services, some of which rely heavily on our community partners to ensure our clients are receiving holistic services.

57 Conclusion Achieving a culturally competent health care organization takes time Barriers must be eliminated that prevent access to quality health care service for MSM of Color Lived experience of the community must be realized and incorporated into programming and services Culturally competent organizations demonstrate better health outcomes for patients and clients Conduct, comprehensive assessment (organizational, system, and providers) to stage the organization along the cultural competency continuum Ensure individual and organizational cultural competence requires ongoing education and training opportunities Engage staff and providers in ongoing discussions of cultural competence 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

58 Contact Information For Further information please contact: Michael Shankle, Special Thanks to Darwin Thompson! 2016 NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT

59 Obtaining CME/CE Credit If you would like to receive continuing education credit for this activity, please visit: NATIONAL RYAN WHITE CONFERENCE ON HIV CARE & TREATMENT